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Mortality rates have been falling for many years and this has been attributed to a number of factors including the quality of medical care and improvement in diet and exercise. Evidence-based guidelines were introduced in the UK in the late 1990s with the aim of reducing disease and mortality.1 Much of this guidance was incorporated into the UK pay for performance programme, the quality and outcomes framework (QOF), which was introduced in 2004 and adopted by almost all English primary care practices. This study aimed to examine the relationship between primary care performance of quality indicators included in the QOF and changes in mortality.
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